The malar, due to its prominent position, is often fractured, either alone or jointly with other bones in the middle of the facial area. Because the body of the malar is relatively strong compared to its processes, it is these processes which are frequently fractured. In the simple fracture-luxation, the zygomatic bone is separated from its union with the frontal bone, the sphenoid bone, the zygomatic arch, and the maxilla; the malar is displaced downward, into the face, and thus the external border is broken. In serious lesions diplopia, other ocular disturbances, and a deterioration of the mandibular function can occur.
Traditional methods of setting the fractured malar use levers or bone hooks. The best known procedure is that of Gillies. It consists of a temporal incision and the introduction of an elevating lever under the aponeurosis of the temporal muscle. Once one end of the lever has reached the fracture, a reduction is attempted by supporting the lever against the bones of the head. Other vias such as the Caldwell-Luc via, and the supraorbital via, and other instruments such as bone hooks, can also be used to lift the sunken bone. All known procedures to date depend upon the strength of the operator.
Most researchers agree that fractures of the zygomatic bone, when seen within the first few days after the lesion, can still be treated satisfactorily by simple methods of elevation. The zygomatic bone generally maintains satisfactory position after the reduction or setting, since the irregular borders of the bony fragments help the bones interlock during the reduction, and since no strong muscular traction exists which could dislocate the acquired position.
Fractures of the zygomatic bone often remain undetected because the soft, tumefactious tissue often hides the depressed parts. Fractures of the malar which remain for a considerable period of time without treatment may undergo a great deal of displacement, may become impacted, or may become partially consolidated. These complications cannot be adequately treated with traditional methods. For this reason means other than those heretofore available are necessary.